Scissors-handle device for surgical instruments



Feb. 14, 1939. 4. E. HELD 2 145 54 'SCISSORS-HANDLE DEVICE FOR SURGICALINSTRUMENTS Filed April 25, 1936 2 Sheets-Sheet 1 I N VE NTOR,

BY JosePhEHe' WW A ORNEY.

Feb. 14, 1939. J. E. HELD 2,146354 SCISSORS-HANDLE DEVICE FOR SURGICALINSTRUMENTS Filed April 25, 1936 2 Sheets-Sheet 2hlllllflililllllllllll" IIHI ZNVENTOR,

JOSQP/IL 11214,

Patented Feb. 14, 1939 "QF-FICE SGIS SORS-HANDLE DEVICE FOB, xSURGIGAIIINSTRUMENTS Joseph E. Held, Woodsideflicng ISIamL NJ Yeassignor to.Amerio'an Cystoscope IL' Makers, :Inc.,

'New York, N. .Y.,.a corporationror New-smirk Application Aprilf25,1936, Serialf'No. 76,331

' 8- Claims.

My present invention relates generally to surgicalinstruments, andhasparticular reference to the typeaof instrument in which a tool .ismounted .for reciprocatoryimovement relative to astationary part such asa stem or sheath.

A general obie'ctof .theinvention is to provide an improved :means, foreffecting .the reciprocating movements of the tool.

In carrying outmy invention, I resortto the use ofapair ofscissors-handles which are adapted to .be grasped bythe surgeon in thesame way as he would grasp anordinary ,pair of scissorspand my improvedtool-actuating meansis associated with the scissorsrhandles. Myinvention. consists insfixedly. associatingone ofthescissors-handles.withthe stationary'part of the instrument, and .providing a-gearsegment on the movable .scissorsehandle, thegear segment .engaging .witharack that .is provided on the .tool

or .othermovable part.

One of .the features of my invention lies .in providing .anindicating-device which is associated with the 'scissorsehandles andwhich .is adapted toindicate the extent .of .reciprocatory movement-of.the .tool when the instrument is used.

By way of -.example,..I have .-herein illustrated and shall hereinafterdescribe vmy. invention as it may be applied to a surgical punch and toa surgical stone crusher,.but it willbe understood that certain phases.of .theinvention-are not restricted to these specificsurgicalinstruments.

In connection Withlthe punch, it isa .further feature .of my invention.to provide .an arrange- 5 mentof parts whichpermits' the punch,together with its associated scissors-handles, to be with- ..drawn inits entirety from the sheath.

In connection with the stone crusher, it isa further feature of myinvention to provide a 40 conduit which may be used simultaneously as anirrigation conduit and as a'tube fonaccommodating a-telescope, the rearend of the conduit being adapted "to be entirely sealed when thetelescope is removed "sothat the conduit-maybe used exclusively forirrigation purposes.

I achievethe foregoing objects, and such'other objects asmayhereinafterappear or-be-pointed out, in the mannerillustratively "exemplified'inthe accompanyingdrawings;wherein- Figure l is a side View of a surgicalpunch showing the manner in which myinvention may be applied-thereto,certain parts beingbroken away for the sake of compactness;

55 Figure '2 is a fragmentary rear elevational viewoi.the-,punch.element or tool, and thisview also showsa,p.ortion..of'the scissors-handles Figure,i3.=is an enlargedcross-sectional view takensubstantially along the line 3-3 of Figure'2;5

,Figure A. is.a..side view of a surgical stone crusher, -showingithemanner in which my invention applied thereto, parts being broken awayior.theisake of :compactness .Ejguref5 .is. a top view of .the .instrumentof 10 Figure A Figure 16. isaifragmentary .elevational view of therearportion .of .the instrument of Figure 4, shownifromflthe opposite side;and

Figure '7 .is .an "enlarged cross-sectional view 15 taken substantiallyalong the v.line .1'l of Figure.4.

.The punch-.ofJFigures '1-"3 .consists .ofa tubular sheath. Jill.havingthe usual forward beak I l, and rearcouplingsleeve.The'lattercarries a pair 20 .of iirrigationpetcocks 13 disposed in.diametrically opposed lrelation, only .one of the petcocks being.vis'ibleJnIEigure L1. The sleeve [2 carries alocking ring [4wbichlisipreferably of the character described and claimed .in UnitedStates 25 Letters'Patent'No. "1,880,551, issued October 4, 1932. Bymeans of'the locking ring M, the .operativeportions of tthe instrument,the elements of which .will be more fully described hereinafter, mayberemovably inserted into association with 30 the sheath.

The member il5, shown most clearly in .Figure'2,is a;p1ug'member lhavinga portion 16 adapted to 'fitfintothesleeve "l2. 'Ihe'portionl'tpreferably carries opposed pins ll which are adapted to-be engaged byand to cooperate with the locking ring 'f4,.as' more fully set forth inthe aforementioneddlhiited States Letters Pat- 'ent No. 138803551. Whenthus engaged, the

memberl-Sforms a fixedrigid portion of the in- 40 strument 'along withthe sheath ID; and the sheath and its associated parts may thus beconsidered, for *the presentpurposes, as a stationarypart of theinstrument.

Rigidlysecured 'tot'hemember l5 isthe scis- 5 sors-handlel8. "Pivotallyconnected to the handle 1T8, as at'the-pivot point -20,-is'thecomplementary or'movable" scissors-handle IS, the two handles,fbeing'a'daptedtobe engaged by the hand-of-an'operator'andimanipulatedbetween the fullline-and dot-and-dashlinepositions of Figure 1.

Carried-bythemovable scissors-handle I9 is a gear-segment-lFWhosecenterof curvature is at the pivot'axis -20. Themember l5is providedwitha slot-or-channel to accommodate the gear 68 segment 2| and permitits movement between the full-line and dot-and-dash line positions ofFigure l.

The teeth of the gear segment 2| mesh with the teeth of a rack 23 whichis carried by the punching tube 24. In the case of a surgical punch,this tube constitutes the tool whose reciprocating movements are to becontrolled by the scissors-handles. The tube 24 is slidably mountedwithin the member l5 so that it moves axially back-and-forthwhen thescissors-handle I9 is moved relative to the fixed scissorshandle l8.

The punching tube 24, per. se, may be of usual construction and has itsforward end sharpened so that it will punch an opening through any bodyor tissue which is engaged in the lateral fenestra 25 of the sheath Ill."Near its rear end, the tube 24 is provided with the opposedlongitudinal slots 26 which register with the irrigation petcocks l3, sothat continuous irrigation may be maintained, if desired,notwithstanding longitudinal movements of the tube 24 relative to thesheath It).

end, the objective 3| being adapted to command a forwardly oblique viewof the fenestra 25.

The characterizing improvements of the surgical punch illustrated, ascompared with punches of conventional construction, reside in the gearsegment 2|; the manner in which this gear segment cooperates with therack 23; and the construction and arrangement of parts which permits thepunching tube, together with its associated scissors-handles l8 and H],to be completely withdrawn from and separated from the sheath. Theability to withdrawn the punching tool is directly attributable to thepresent improved arrangement whereby the fixed scissors-handle I8 isrigidly secured to the plug member I5, the latter being adapted to beseparably interlocked into rigid association with the sleeve I2.

As a result of the gear segment element, improved operation is achievedby virtue of the fact that the actuating forceis always applied to themovable tube 24 at apoint directly above the pivot axis 20,.throughoutthe entire manipulation of the scissors-handles. Accordingly, a uniformand more controllable force may be applied to the punching tubethroughout its entire operative stroke.

In Figures 4-7, I have illustrated the manner in which the ,scissorshandle improvement may be applied to a surgical stone crusher. The fixedscissors-handle 40 is pivoted to the movable handle 4| at the pivot axis42. The fixed handle 40 is rigidly secured to the block 43 forming aportion of the relatively stationary part of the instrument. The block43 is provided with a slot or channel to accommodate the gear segment 44which is mounted on the upper portion of the movable scissors-handle 4|.The block 43 is also provided with at least one irrigation'outlet orpetcock; and I have illustratively shown the preferred construction inwhich an outlet 45 extends upwardly, and a somewhat larger outlet .46extends laterally. Projecting forwardly fromfthe block 43 is a fixedstem 41 carrying a fixed crushing jaw 48 at its forward end. One portionof the stem is provided with a longitudinal T-slot, as shown mostclearly in Figure 7, and within this slot a movable stem 49 is mounted,this movable part of the instrument carrying at its forward end thecomplementary crushing jaw 50, and at its rear end the rack 5| whichmeshes with the gear segment 44.

In the embodiment illustrated in Figures 47, the block 43 is providedwith the fixed indicator plate 52, and the movable handle 4| carries thepointer 53 which is adapted to move over the plate 52. The position ofthe pointer 53 on scale 52 indicates to the operator the relativeposition of the movable crushing jaw. For example, with the parts in thefull-line position of Figure 4, the two jaws 48 and are in their fullyclosed relationship, and the pointer 53 is, therefore, positioned overthe designation Closed on the plate 52. As the movable jaw 50 iswithdrawn from the fixed jaw 48, by virtue of the manipulation of thescissors-handles, and the interengagement between the gear segment 44-and the rack 5|, the pointer 53 moves over the dial 52. The latter ispreferably provided with markings arranged to indicate the distancebetween the jaws in millimeters, thus permitting the operator todetermine the size of a stone before the crushing operation, andpermitting him also to make sure that the jaws are in fully closedrelationship after the crushing procedure.

A lateral portion of the fixed stem 47 is hollowed out to provide aconduit 54 most clearly indicated, in Figure 7. This conduitcommunicates with an aligned bore extending through the block 43, andthe conduit continues rearwardly 'of the block 43, as indicated inFigures 4 and 5.

At its rear end, the conduit is provided with a K clamp 55, and just infront of the clamp 55 is a-valve device 56, including a rotatable plugelement' which is controlled by the handle 57. When the handle 5'! is inthe longitudinal disposition shown in full-lines in the drawings, alongitudinal bore in the plug element is aligned with the conduit 54 andforms a portion thereof. Accordingly, a telescope tube 58 may belongitudinally disposed within the conduit 54, as shown in the drawings.This telescope may be of any suitable construction, having the usualeyepiece 59 at its rear end and provided with a lamp 60 at its forwardend, and with an objective which commands a view of the operative rangeof the crushing jaws. serted, a pin 6| carried thereby engages within aslot 52 in the clamping device 55; and the forward. portion of thetelescope protrudes by a slight amount by the forward opening end of theconduit 54. The pin 6| assures a proper disposition of the telescope sothat the objective will be facing in the correct direction so as tocommand the desired view of the operative range of the laws.

The conduit 54 is slightly oversized with respect to the telescope tube,so that the petcocks 45 and 46 may be used during the crushing procedureto irrigate the region of operation. When a stone has been completelycrushed, it is desirable to permit the fragments to be flushed out ofthe body through as large a passageway as possible. Accordingly, thepresent invention provides for the complete rearward withdrawal of thetelescope so that the conduit 54 may be utilized to its fullest extentfor flushing purposes. With this object in view, the valve device 56 isprovided, the manipulation of the plug element, by swinging the handle51 into the dot-and-dash position of Figure 5, serving to plug and sealWhen the telescope is fully inthe rear end of the conduit 54 after thetelescope has been withdrawn.

It will be understood that the structural improvements involving theconduit 54, the irrigation outlets connected with it, and the valvedevice 56, are phases of the invention independent of the means wherebythe movable jaw is reciprocated.

In general, it will be understood that changes in the details, hereindescribed and illustrated for the purpose of explaining the nature of myinvention, may be made by those skilled in the art without departingfrom the spirit and scope of the invention as expressed in the appendedclaims. It is, therefore, intended that these details be interpreted asillustrative, and not in a limiting sense.

Having thus described my invention, and illustrated its use, what Iclaim as new and desire to secure by Letters Patent is 1. In a surgicalpunch, a sheath having a fenestra therein, a punching tool mountedwithin the sheath for longitudinal reciprocatory movement relative tothe fenestra, a pair of pivoted scissors-handles one of which is rigidlysecured to the rear of the sheath, a rack carried by the rearwardportion of the punching tool, and a gear segment carried by the movablescissors-handle and meshing with said rack.

2. In a surgical punch, a sheath, a punching tool adapted to reciprocatewithin the sheath, a pair of pivoted scissors-handles for controllingthe movements of the punching tool, and means for separably locking oneof the scissors-handles into rigid association with the rear of thesheath.

3. In a surgical punch, a sheath, a punching tool adapted to reciprocatewithin the sheath, a pair of pivoted scissors-handles for controllingthe movements of the punching tool, and means for separably locking oneof the scissors-handles into rigid association with the rear of thesheath, said means comprising a sleeve on the rear end of the sheath, aplug member fixedly secured to one of the scissors-handles, and areleasable means for interlocking said sleeve and plug member.

4. In a. surgical punch, a sheath having a sleeve at its rear end, apunching tool adapted to reciprocate within the sheath, a rack on therear end of the punching tool, a pair of pivoted scissorshandles forcontrolling the movements of the punching tool, a gear segment on one ofthe handles and meshing with said rack, and means for separably lockingthe other scissors-handle into rigid association with said sleeve.

5. In a surgical punch, a sheath having a sleeve at its rear end, apunching tool adapted to reciprocate within the sheath, a rack on therear end of the punching tool, a pair of pivoted scissorshandles forcontrolling the movements of the punching tool, a gear segment on oneofv the handles and meshing with said rack, and means for separablylocking the other scissors-handle into rigid association with saidsleeve, said means comprising a plug member fixedly secured to saidscissors-handle, and a releasable means for interlocking said plugmember with said sleeve.

6. In a surgical punch, a sheath having a sleeve at its rear end, apunching tool adapted to reciprocate within the sheath, a rack on therear end of the punching tool, a plug member adapted to fit into saidsleeve and provided with a bore which slidably accommodates saidpunching tool and rack, a pair of pivoted scissors-handles one of whichis fixedly secured to said plug member, a gear segment on the otherhandle and meshing with said rack, and a releasable means forinterlocking said plug member and sleeve into rigid association.

7. In a surgical punch, the combination with the elements set forth inclaim 1, of a telescope arranged longitudinally with respect to saidsheath with its eyepiece projecting rearwardly therefrom, both of saidhandles extending in a substantially transverse direction away from thesheath so as to leave the eyepiece of the telescope accessible duringmanipulation of the scissors-handles.

8. In a surgical punch, the combination of elements set forth in claim1, the rigidly secured scissors-handle extending at an angle of about 45to the axis of said sheath, the other scissorshandle being arrangeddirectly in front of the first-named scissors-handle when the handlesare closed. JOSEPH E. HELD.

